The Rise of Black Fungus Infection
by Adel Eldin, MD, FACC, FACP, MBA, GGA
The recent rise of lethal black fungus infection in India as well as the death of the very iconic Egyptian comedian Sameer Ghanem have brought this unusual infection to the spotlight!
This was noted among patients diagnosed with COVID-19 infection and is being treated with Intravenous corticosteroids ( Dexamethasone) to decrease the inflammation in the lung tissue caused by Coronavirus infection.
Black fungus or Mucormycosis is a disease caused by many fungi which are usually found in the environment, in soil, and often associated with decaying organic material such as fruits or vegetables. Black fungus is an opportunistic infection that attacks people with a weakened immune system caused by immunosuppressive drugs used for auto-immune diseases, cancer patients, or after organ transplants, diabetes, but more commonly noted with steroid use that would lead to the marked rise of blood sugar levels and cause diabetes
Patients can inhale spores of Mucormycosis or swallowing food contaminated with its spores. or spores-contaminated wounds. Every day, we all inhale spores of many fungi but if the immune system is strong and healthy, then no infection will occur. On the other hand, if the tissues become relatively acidic in poorly controlled diabetic patients, then fungi will grow. That is why 40% of cases infected with fungi were diagnosed in diabetic patients.
Among COVID-19 patients, Mucormycosis infection( Black Fungus) was found in 94% of patients who were diabetic. 67% of all diabetics had uncontrolled diabetes. Unfortunately, people with severe COVID-19 are treated with Intravenous steroids as a part of therapy for severe COVID-19 infection as it will damage tissues and blood vessels and thus increase the chances of contracting Mucormycosis( black Fungus ) infection. Another opportunistic fungal infection called Aspergillosis found in patients with severe COVID-19 infection who are being treated at the same time with steroids that will increase blood sugar levels in an attempt to decrease inflammation in the lung and thus improve oxygenation and survival.
Aspergillosis is the most common global opportunistic fungal infection which is much faster to diagnose compared to ( Black Fungus) or Mucormycosis infection which can cause blindness, headaches, and seizures and its diagnosis are late. Thus, Black Fungus leads to a 50% mortality rate compared to a 1-2% death rate with COVID-19 infection. The sharp rise of Black Fungus cases in India has prompted many to review the premature and unjustified use of Intravenous steroids through panic. The steroid therapy should be reserved for severe COVID-19 cases with low Oxygen levels or requiring intubation and mechanical ventilation only to limit this explosion of thousands of new cases of Mucormycosis leading to high death rates. This could have been prevented by taking measures such as early diagnosis once suspected, start Intravenous Anti Fungal therapy such as Amphotericin B. Surgery to remove dead or infected tissue, and proper sterile wound care. Use of sterile water for humidifiers used during Oxygen therapy. Strengthening the immune system would be critical in preventing the Black Fungus infection, controlling diabetes, avoid steroid dose unless it is absolutely needed.
Finally, a team approach would include an eye doctor, Ear, Nose, and Throat Doctor, Neurologist, dentist, and Intensive care specialist to be able to coordinate the patient medical care considering the very high mortality rate associated with Black Fungus infection globally.